In 2024, the World Health Organization formally declared Egypt malaria-free, marking a momentous public health triumph for a nation exceeding 100 million inhabitants, a century-long struggle against this age-old scourge finally reaching its conclusion. “Malaria is as old as Egyptian civilisation itself, but the disease that plagued pharaohs now belongs to history, not the future,” remarked WHO Director-General Tedros Adhanom Ghebreyesus.
In 2023, the global malaria burden remained grave, with an estimated 263 million cases and roughly 597,000 deaths recorded worldwide. By the close of 2024, a total of 44 countries and one territory had achieved malaria-free certification, including Egypt and Cabo Verde. But the pressing question endures: can other African nations follow suit, and what strategic framework might deliver the continent’s malaria endgame?
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Egypt’s achievement is nothing short of inspirational. It followed nearly a century of layered interventions, ranging from early vector-control measures such as the prohibition of rice cultivation near homes in the 1920s, to large-scale outbreak management and sustained surveillance networks. While its epidemiological and environmental context differs from many Sub-Saharan African nations, Egypt’s elimination strategy offers a replicable template: one built on cross-sectoral coordination, adaptation to local conditions, and unwavering commitment to public health infrastructure. Yet, the vast disparities in disease burden and resource capacity across the continent imply that Africa’s path to widespread malaria elimination will require bespoke strategies, scaled investments, and resilient health systems.
Africa’s Current Burden in Numbers
In 2023, malaria remained a pressing burden: 263 million cases were recorded globally, with deaths totalling approximately 597,000. The African Region accounted for approximately 94 per cent of cases and 95 per cent of deaths, with the most vulnerable being children under five, who bore an estimated 76 per cent of the fatalities. The majority of malaria mortality was concentrated in only a handful of nations, Nigeria alone accounted for nearly a third of tropical malaria deaths, followed by the Democratic Republic of the Congo, Niger, and Tanzania.
Though progress is undeniable, since 2000, interventions have averted an estimated 2.2 billion malaria cases and 12.7 million deaths globally, the trajectory has recently plateaued. The year 2023 saw an increase of 11 million cases compared with the year before. While mortality rates have declined overall, these gains remain fragile and easily reversible, particularly in fragile health systems across Sub-Saharan Africa.
Challenges That Stall the Surge Forward
Africa’s malaria battleground is beset by converging threats that jeopardise advances. Climate change and conflict have wrought unpredictable disease surges and disrupted healthcare access, notably through flooding, displacement, and the destruction of critical infrastructure. Funding shortfalls represent another chasm: analysts estimate that annual global malaria control requires at least 6.8 billion US dollars, more than double the current funding levels of around 3.5 billion US dollars.
Meanwhile, proposed cuts to international initiatives such as the US President’s Malaria Initiative, responsible for averting millions of cases each year could result in more than 13 million additional malaria cases and tens of thousands of preventable deaths if enacted. The looming threat of insecticide and artemisinin drug resistance further undermines control strategies, exposing cracks in the arsenal that has underpinned progress over the past two decades.
Innovations Lighting a New Path
Despite these obstacles, notable breakthroughs brighten Africa’s malaria horizon. The Swiss-approved Coartem Baby (Riamet Baby) is the first antimalarial formulated specifically for infants and newborns, cherry-flavoured, easily dissolvable, and adapted for resource-limited settings, already authorised in several African countries.
In parallel, vaccination progress has accelerated. The RTS,S (Mosquirix) vaccine, used across high-transmission settings, has helped reduce severe malaria admissions by around 30 per cent. More promising still, the R21/Matrix-M vaccine, now approved in Ghana and provisionally in Nigeria has demonstrated efficacy of 77 per cent in trials, crossing the WHO’s 75 per cent threshold for vaccine effectiveness. If deployed at scale alongside bed nets, preventive therapies, and prompt case management, these vaccines could radically shift Africa’s malaria trajectory.
Stitching Together Africa’s Malaria Endgame
Africa’s journey to malaria freedom must be tied to a coherent, continent-wide framework anchored in adaptive strategy, sustained investment, and global solidarity. This framework unfolds across four interlinked pillars.
First is strengthening primary health systems, embedding robust surveillance, diagnostic, and treatment networks within community-level health structures. These systems must be nimble enough to respond to surges, yet resilient in low-transmission settings.
Second, targeted deployment of innovations, vaccines, new paediatric treatments, and more effective bed net must be expanded and integrated across high-burden regions. Such tools, when matched with timely data, can transform outcomes.
Third, mobilising sustainable financing is imperative. With global threats and shifting donor priorities, African nations must diversify their funding sources, including expanding domestic health budgets, engaging with regional financing mechanisms, and advocating for renewed international commitments.
Finally, regional cooperation and adaptability remain essential. Border regions and migrating populations pose particular challenges; regional coordination can pre-empt transmission rebound. Interventions must be tailored to local ecological and social dynamics while remaining aligned with continental strategies such as the African Union’s Catalytic Framework to End AIDS, TB and Eliminate Malaria by 2030.
Nurturing the Sunrise of a Malaria-Free Africa
Egypt’s malaria-free certification is a rising sun: a testament to persistent public health endeavour, capable of illuminating the path for the rest of Africa. The challenge ahead is formidable, but not insurmountable. If African nations align political will, scientific innovation, and global support, guided by a clear framework, the continent could transform malaria from a perennial tragedy into a chapter of the past.
Above all, the battle against malaria in Africa calls for more than tools, it demands unwavering human resolve, ethical leadership, and the conviction that every child deserves a future free of this ancient killer.
